ATI RN
Pregnancy Assessment Questions Questions
Question 1 of 5
A client, 6 cm and 80% effaced, has just received Demerol (meperidine) 50 mg IV for pain. Which of the following fetal heart changes would the nurse expect to observe on the internal fetal monitor tracing?
Correct Answer: C
Rationale: In this scenario, the correct answer is C) Decrease in variability. Meperidine (Demerol) is an opioid analgesic that can cross the placental barrier and affect the fetus. Opioids can lead to central nervous system depression in both the mother and the fetus, resulting in a decrease in variability on the fetal heart monitor tracing. Variability is an important indicator of fetal well-being, so a decrease in variability can be concerning. Option A) Drop in baseline heart rate is not typically associated with meperidine administration, as opioids usually do not cause a direct drop in the baseline fetal heart rate. Option B) Increase in number of variable decelerations is not a common effect of meperidine. Variable decelerations are usually associated with cord compression, not opioid administration. Option D) Rise in number of early decelerations is also not a typical response to meperidine. Early decelerations are often considered benign and are associated with head compression during contractions. It is crucial for nurses and healthcare providers to understand the effects of medications on both the mother and fetus during pregnancy to provide safe and effective care. Monitoring fetal well-being during labor is essential to ensure timely intervention if any abnormalities are detected, especially when medications like opioids are involved.
Question 2 of 5
A mother, 39 weeks’ gestation, is admitted to the labor suite with rupture of membranes 15 minutes earlier and contractions q 8 minutes × 30 seconds. On vaginal exam, the cervix is 4 cm dilated and 80% effaced, and the station is –2. The baby is found to be in the LSP position. The fetal heart rate is 144 with average variability and variable decelerations. Which of the following complications of labor must the nurse assess this client for at this time?
Correct Answer: D
Rationale: In this scenario, the correct answer is D) Prolapsed cord. A prolapsed cord is a serious obstetrical emergency that occurs when the umbilical cord descends through the cervix alongside or ahead of the presenting part of the fetus. This can lead to cord compression, compromising fetal blood flow and oxygenation, resulting in fetal distress or even death. Option A) Precipitous delivery is incorrect because while the labor is progressing, there is no indication that delivery will be unusually rapid in this case. Option B) Chorioamnionitis is less likely at this moment as the focus should be on the immediate obstetric emergency of a prolapsed cord. Option C) Uteroplacental insufficiency is not the primary concern in this scenario as the fetal heart rate with average variability and variable decelerations suggests ongoing oxygenation to the fetus. Educationally, understanding obstetric emergencies like prolapsed cord is crucial for nurses and healthcare providers working in labor and delivery settings. Prompt recognition and intervention are essential to prevent adverse outcomes for both the mother and the baby. This case highlights the importance of critical thinking and quick decision-making skills in managing emergent situations during labor and delivery.
Question 3 of 5
The nurse is caring for a client and her partner who just birthed a 33-week fetal demise. Which of the following actions by the nurse is appropriate at this time?
Correct Answer: C
Rationale: In this scenario, the most appropriate action by the nurse is option C: Ask the couple if they would like to hold their baby. This choice demonstrates compassionate and patient-centered care during a highly sensitive and emotionally challenging situation. Allowing the parents the opportunity to hold their baby provides them with a chance to create memories and say goodbye, which can aid in their grieving process and facilitate closure. Option A is incorrect because moving the woman to a medical unit may not address the emotional needs of the couple during this difficult time. Option B is also inappropriate as refraining from discussing the loss with the couple can lead to feelings of isolation and lack of support. Option D is not the priority at this moment as obtaining a milk suppressant for the mother does not address the immediate emotional needs of the couple. Educationally, this question highlights the importance of providing holistic care to patients, especially in emotionally charged situations like perinatal loss. It emphasizes the significance of communication, empathy, and sensitivity in nursing practice, particularly when caring for individuals experiencing grief and loss.
Question 4 of 5
During a postpartum examination, the nurse notes that a client’s left calf is warm and swollen. Which of the following actions by the nurse is appropriate at this time?
Correct Answer: A
Rationale: In this scenario, option A is the correct choice for the nurse to take - notifying the client's physician. This symptom of a warm, swollen left calf could indicate deep vein thrombosis (DVT), a serious condition where a blood clot forms in a deep vein. It is crucial for the physician to assess the client promptly to prevent potential complications like pulmonary embolism. Option B, teaching the client to massage her leg, is incorrect as massaging a suspected DVT can dislodge the clot and lead to serious consequences. Option C, applying ice packs, is also inappropriate as cold therapy can further increase the risk of clot formation. Option D, encouraging ambulation, is contraindicated as it can potentially dislodge the clot and lead to embolism. Educationally, this question highlights the importance of recognizing signs of DVT in postpartum women, who are at higher risk due to factors like immobility during childbirth. Nurses need to be vigilant in assessing such symptoms and understanding the appropriate interventions to ensure the safety and well-being of their patients. Early detection and intervention in such cases are critical to prevent adverse outcomes.
Question 5 of 5
Without doing a vaginal examination, a nurse concludes that a primigravida, who has received no medications during her labor, is in transition. Which of the following signs/symptoms would lead a nurse to that conclusion?
Correct Answer: B
Rationale: In pharmacology, understanding the signs and symptoms of labor progression is crucial for nurses to provide appropriate care during pregnancy. In this scenario, option B is correct because yelling at her partner and vomiting are indicative of the transition phase of labor. During transition, women often exhibit signs of emotional and physical intensity, such as irritability and nausea, which are reflected in this response. Option A, where the woman fell asleep during a contraction, is incorrect because it suggests a lack of awareness and responsiveness, which are not typical of the transition phase. Option C, where the woman laughed at something on the television, is also incorrect as it indicates a relaxed and possibly distracted state, which is not characteristic of transition. Option D, where the woman began pushing with each contraction, is incorrect because pushing typically occurs during the second stage of labor, not during transition. It is important for nurses to recognize the signs of each stage of labor to provide appropriate support and interventions to ensure the well-being of both the mother and the baby.